The role of nuclear cardiac imaging in risk stratification of sudden cardiac death

Juneau, Daniel; Erthal, Fernanda; Chow, Benjamin J.W.; Redpath, Calum J.; Ruddy, Terrence D.; Knuuti, Juhani

doi:10.1007/s12350-016-0599-8

Cited by 5 publications

(4 citation statements)

References 142 publications

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“…Nuclear medicine presents another advanced imaging modality that has been applied for risk stratification of SCD ( 68 ). Single-photon emission computer tomography (SPECT) is commonly used in cardiology for myocardial perfusion imaging (MPI) to assess coronary patency ( 69 ).…”

Section: Nuclear Imagingmentioning

confidence: 99%

Advanced imaging for risk stratification for ventricular arrhythmias and sudden cardiac death

Xie

Sung

Saad

et al. 2022

Front. Cardiovasc. Med.

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Sudden cardiac death (SCD) is a leading cause of mortality, comprising approximately half of all deaths from cardiovascular disease. In the US, the majority of SCD (85%) occurs in patients with ischemic cardiomyopathy (ICM) and a subset in patients with non-ischemic cardiomyopathy (NICM), who tend to be younger and whose risk of mortality is less clearly delineated than in ischemic cardiomyopathies. The conventional means of SCD risk stratification has been the determination of the ejection fraction (EF), typically via echocardiography, which is currently a means of determining candidacy for primary prevention in the form of implantable cardiac defibrillators (ICDs). Advanced cardiac imaging methods such as cardiac magnetic resonance imaging (CMR), single-photon emission computerized tomography (SPECT) and positron emission tomography (PET), and computed tomography (CT) have emerged as promising and non-invasive means of risk stratification for sudden death through their characterization of the underlying myocardial substrate that predisposes to SCD. Late gadolinium enhancement (LGE) on CMR detects myocardial scar, which can inform ICD decision-making. Overall scar burden, region-specific scar burden, and scar heterogeneity have all been studied in risk stratification. PET and SPECT are nuclear methods that determine myocardial viability and innervation, as well as inflammation. CT can be used for assessment of myocardial fat and its association with reentrant circuits. Emerging methodologies include the development of “virtual hearts” using complex electrophysiologic modeling derived from CMR to attempt to predict arrhythmic susceptibility. Recent developments have paired novel machine learning (ML) algorithms with established imaging techniques to improve predictive performance. The use of advanced imaging to augment risk stratification for sudden death is increasingly well-established and may soon have an expanded role in clinical decision-making. ML could help shift this paradigm further by advancing variable discovery and data analysis.

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Section: Nuclear Imagingmentioning

confidence: 99%

Advanced imaging for risk stratification for ventricular arrhythmias and sudden cardiac death

Xie

Sung

Saad

et al. 2022

Front. Cardiovasc. Med.

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“…Myocardial substrate metabolism can be studied in detail by fatty acid analogs, such as 18F-fluoro-6-thia-heptadecanoicacid or 11C-palmitate. The former reflects myocardial fatty acid utilization, whereas the latter reflects the flux of fatty acid metabolism through the cell including lipid pool storage, beta-oxidation, and tricarboxylic acid cycle [96]. Imaging of myocardial metabolism with PET has been used for evaluation of many medical and device therapies on the metabolism of the failing heart [94,95].…”

Section: Myocardial Metabolismmentioning

confidence: 99%

“…Cardiac sympathetic imaging provides a non-invasive approach to assess alterations in cardiac sympathetic nerve function in cardiomyopathies [96,97]. Heart failure is associated with an increased sympathetic tome characterized by increased release and decreased reuptake of norepinephrine by cardiac sympathetic nerve endings.…”

Section: Cardiac Sympathetic Innervationmentioning

confidence: 99%

“…Cardiac uptake is usually measured relative to background mediastinal activity in planar images (heart-to-mediastinum ratio). Many studies have demonstrated that cardiac uptake of 123I-MIBG is reduced in individuals with heart failure and indicate that 123I-MIBG can be used as an independent predictor of heart failure progression and cardiac mortality [96][97][98][99].…”

Section: Cardiac Sympathetic Innervationmentioning

confidence: 99%

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Molecular Imaging to Monitor Left Ventricular Remodeling in Heart Failure

Ylä-Herttuala

Saraste

Knuuti

et al. 2019

Curr Cardiovasc Imaging Rep

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Purpose of Review Cardiovascular diseases are the leading cause of deaths worldwide. Many complex cellular and molecular pathways lead to myocardial remodeling after ischemic insults. Anatomy, function, and viability of the myocardium can be assessed by modern medical imaging techniques by both visualizing and quantifying damages. Novel imaging techniques aim for a precise and accurate visualization of the myocardium and for the detection of alternations at the molecular level. Recent Findings Magnetic resonance imaging assesses anatomy, function, and tissue characterization of the myocardium noninvasively with high spatial resolution, sensitivity, and specificity. Using hyperpolarized magnetic resonance imaging, molecular and metabolic conditions can be assessed non-invasively. Single photon-emission tomography and positron-emission tomography are the most sensitive techniques to detect biological processes in the myocardium. Cardiac perfusion, metabolism, and viability are the most common clinical targets. In addition, molecular-targeted imaging of biological processes involved in heart failure, such as myocardial innervation, inflammation, and extracellular matrix remodeling, is feasible. Summary Novel imaging techniques can provide a precise and accurate visualization of the myocardium and for the detection of alternations at molecular level.

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PET imaging in heart failure: the role of new tracers

Saraste

Knuuti

2017

Heart Fail Rev

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Positron emission tomography (PET) myocardial perfusion imaging is being increasingly used for the detection of coronary artery disease. In the presence of significant left ventricle dysfunction, the assessment of myocardial ischemia and viability by PET plays a role in the identification of patients who may benefit from revascularization. In addition to these, new PET tracers may play a role in the assessment of underlying pathophysiology and therapeutic options in heart failure. Studies have shown the ability of sympathetic innervation imaging to assess the risk of cardiac death, arrhythmia, and disease progression. New tracers have been tested for the assessment of angiogenesis and other mechanisms involved in myocardial repair after infarction. Furthermore, new tracers may play a role in detection of inflammatory cardiomyopathies, especially cardiac sarcoidosis, which is a diagnostic challenge for current methods. In addition to the assessment of prognosis and etiology, the value of new PET tracers will depend on their ability to guide selection of therapies and incorporation into clinical management algorithms in heart failure. This review describes recent advances in applications of cardiac PET in heart failure with emphasis on potential roles of new tracers.

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The role of nuclear cardiac imaging in risk stratification of sudden cardiac death

Cited by 5 publications

References 142 publications

Advanced imaging for risk stratification for ventricular arrhythmias and sudden cardiac death

Advanced imaging for risk stratification for ventricular arrhythmias and sudden cardiac death

Molecular Imaging to Monitor Left Ventricular Remodeling in Heart Failure

PET imaging in heart failure: the role of new tracers

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